Given AHRQ's focus on improving health outcomes and advancing methodologies in health services research, including cost-effectiveness analysis, the present application has three aims: Specific Aim # 1 (Primary Aim): Develop a content valid survey that can be used to measure high- performance work systems (HPWS) practices in a hospital setting. Specific Aim # 2: Relate HPWS practices to patient safety and quality in the healthcare industry, which will allow for the estimation of a) internal consistency, b) construct validity, and c) criterion validity. Hypothesis: The extent that HPWS practices are used in hospitals will be positively related to the patient safety and quality in hospitals. Specific Aim # 3: Determine the cost effectiveness of implementing different HPWS practices to determine which HPWS practices provide the most impact on patient safety and quality per dollar spent on HPWS practices. A mixed methods approach will be used for this study, including the development and administration of a survey that collects qualitative and quantitative information about HPWS in hospitals throughout the United States. The first part of the study will consist of survey development and refinement with assistance from the Pi's mentor (Dr. Eric Thomas) and two content experts (Dr. Cynthia St. John and Dr. Michal Tamuz). The second part of the study will consist of administering the survey about HPWS practices to a random sample of hospitals in 25 of the states in the U.S. and linking the survey responses with three criteria - Hospital Quality Alliance data, clinical excellence rates, and patient safety rates, where the latter two rates are computed using methodology developed by Health Grades Inc. that incorporates AHRQ's patient safety indicator framework. The third part of the study will examine the cost effectiveness of the HPWS practices for each of the criteria. The present study seeks to identify work practices used by organizations that are related to health outcomes. To accomplish this, the present study will look for similarities and differences in work practices used by high- and low-performing hospitals.